Pretransplantation factors predict for treatment-related myelodysplastic syndrome after SCT

10-04-2006

Pretransplantation factors predict for treatment-related myelodysplastic syndrome after autologous stem cell transplantation.

"The risk factors for treatment-related myelodysplastic syndrome (t-MDS) and acute myelogenous leukemia (AML) after autologous stem-cell transplantation (ASCT) are similar to those that increase the risk of difficult stem-cell harvests.

"We reviewed our experience in 526 patients with lymphoma treated by ASCT to determine whether difficult stem-cell harvests predict for an increased risk of t-MDS/AML," scientists in the United States report.

According to researchers, "Autologous peripheral stem cells were initially mobilized with granulocyte colony-stimulating factor (G-CSF; or granulocyte-macrophage colony-stimulating factor) alone (n=334), etoposide and G-CSF (n=166), or cyclophosphamide and G-CSF with or without etoposide (n=26).

"Difficult harvests were those that required more than 5 days to collect enough stem cells and those that required additional attempts with etoposide and/or cyclophosphamide plus G-CSF (n=52). All patients were then treated with high-dose chemotherapy alone and observed for outcome."

"With a median follow-up time for surviving patients of 69 months," wrote M. Kalaycio and colleagues at the Cleveland Clinic Foundation, "20 patients developed t-MDS/AML, for an actuarial incidence of 6.8% at 10 years.

"Pretransplantation characteristics, including age, diagnosis of non-Hodgkin's lymphoma or Hodgkin's disease, bone marrow involvement, prior radiation therapy, prior exposure to chemotherapy, lactate dehydrogenase at the time of ASCT, disease status, and method of stem-cell mobilization, were then analyzed with respect to the subsequent development of t-MDS/AML."

"By multivariable analysis," said Kalaycio, "prior exposure to radiation therapy, four or more chemotherapy regimens, and more than 5 days of apheresis needed to harvest enough stem cells were identified as independent risk factors for t-MDS/AML. Bootstrap analysis confirmed these results."

The authors concluded, "These results suggest that identifiable pretransplantation factors predict for t-MDS/AML after ASCT."

Kalaycio and colleagues published their study in the Journal of Clinical Oncology (Risk factors before autologous stem-cell transplantation for lymphoma predict for secondary myelodysplasia and acute myelogenous leukemia. J Clin Oncol, 2006;24(22):3604-3610).

For more information, contact M. Kalaycio, 9500 Euclid Avenue R35, Cleveland, OH 44195, USA.

Publisher contact information for the Journal of Clinical Oncology is: American Society Clinical Oncology, 330 John Carlyle St., Ste. 300, Alexandria, VA 22314, USA.

Keywords: Cleveland, Ohio, United States, Treatment-Related Myelodysplastic Syndrome, Autologous Stem Cell Transplantation, Pretransplantation Factors, Acute Myelogenous Leukemia.

This article was prepared by Clinical Oncology Week editors from staff and other reports. Copyright 2006, Clinical Oncology Week via NewsRx.com.